CT Scans and Acute Appendicitis: A Five-Year Analysis from a Rural Teaching Hospital
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Studies examining the relationship between computed tomography (CT) scans and appendiceal perforation have largely been conducted in urban centers. The present study sought to evaluate this relationship in a rural hospital.
Methods and Procedures
This is a retrospective analysis of 445 patients who underwent appendectomies from January 2000 to June 2005 at a rural teaching hospital.
Four hundred forty-five patients were analyzed in two groups; those who underwent CT scans (N = 245) and those who did not (N = 200). Patients undergoing CT scans were significantly older (median age 38 vs. 22 years, P < 0.0001), were more likely to have perforated appendicitis (P 0.001), were less likely to undergo a negative appendectomy (P = 0.003), and had a significantly longer length of stay than those who did not (P 0.009). Analysis by gender showed that perforation rates continued to be significantly higher in males undergoing CT scans (P 0.004). To examine the possibility that sicker patients were more likely to receive CT scans and also be found to have perforated appendicitis, a sensitivity analysis was performed. Patients showing perforated appendicitis on initial CT scans were excluded and the analysis was repeated. The difference in perforation rates continued to remain significant (P 0.037).
Males undergoing CT scans are significantly more likely to have perforated appendicitis. A protocol-driven rational approach to CT evaluation of suspected appendicitis may lower perforation rates, especially in males.
- Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg 1975;110:677–684.
- Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg 1984;200:567–575. doi:10.1097/00000658-198411000-00002. CrossRef
- Stroman DL, Bayouth CV, Kuhn JA, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg 1999;178:485–489. doi:10.1016/S0002-9610(99)00223-8. CrossRef
- Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol 1998;93:768–771. doi:10.1111/j.1572-0241.1998.222_a.x. CrossRef
- Lane MJ, Liu DM, Huynh MD, et al. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 1999;213:341–346.
- Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998;338:141–146. doi:10.1056/NEJM199801153380301. CrossRef
- Brandt MM, Wahl WL. Liberal use of CT scanning helps to diagnose appendicitis in adults. Am Surg 2003;69:727–731, discussion 731–722.
- Wilson EB, Cole JC, Nipper ML, et al. Computed tomography and ultrasonography in the diagnosis of appendicitis: when are they indicated? Arch Surg 2001;136:670–675. doi:10.1001/archsurg.136.6.670. CrossRef
- Hershko DD, Sroka G, Bahouth H, et al. The role of selective computed tomography in the diagnosis and management of suspected acute appendicitis. Am Surg 2002;68:1003–1007.
- DeArmond GM, Dent DL, Myers JG, et al. Appendicitis: selective use of abdominal CT reduces negative appendectomy rate. Surg Infect (Larchmt) 2003;4:213–218. doi:10.1089/109629603766957013. CrossRef
- Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 2005;201:933–939. doi:10.1016/j.jamcollsurg.2005.04.039. CrossRef
- Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001;286:1748–1753. doi:10.1001/jama.286.14.1748. CrossRef
- Weyant MJ, Eachempati SR, Maluccio MA, et al. Interpretation of computed tomography does not correlate with laboratory or pathologic findings in surgically confirmed acute appendicitis. Surgery 2000;128:145–152. doi:10.1067/msy.2000.107422. CrossRef
- Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 2001;136:556–562. doi:10.1001/archsurg.136.5.556. CrossRef
- Garfield JL, Birkhahn RH, Gaeta TJ, Briggs WM. Diagnostic pathways and delays on route to operative intervention in acute appendicitis. Am Surg 2004;70:1010–1013.
- McGory ML, Zingmond DS, Nanayakkara D, et al. Negative appendectomy rate: influence of CT scans. Am Surg 2005;71:803–808.
- Darling AP, Mc IM. Acute appendicitis in a rural community. Ann Surg 1950;131:307–315. doi:10.1097/00000658-195003000-00002. CrossRef
- McIver MA, Broadaway RK. Acute appendicitis in a rural community series III: twenty-five year summary. Ann Surg 1957;145:552–556. doi:10.1097/00000658-195704000-00012. CrossRef
- Clements N, Olson JE, Powers JH. Acute appendicitis in a rural community. Iv. Ann Surg 1965;161:231–237. doi:10.1097/00000658-196502000-00012. CrossRef
- Bixby SD, Lucey BC, Soto JA, et al. Perforated versus nonperforated acute appendicitis: accuracy of multidetector CT detection. Radiology 2006;241:780–786. doi:10.1148/radiol.2413051896. CrossRef
- Perez J, Barone JE, Wilbanks TO, et al. Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis. Am J Surg 2003;185:194–197. doi:10.1016/S0002-9610(02)01364-8. CrossRef
- Jones K, Pena AA, Dunn EL, et al. Are negative appendectomies still acceptable? Am J Surg 2004;188:748–754. doi:10.1016/j.amjsurg.2004.08.044. CrossRef
- Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004;141:537–546.
- Balthazar EJ, Birnbaum BA, Yee J, et al. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994;190:31–35.
- Balthazar EJ, Megibow AJ, Siegel SE, Birnbaum BA. Appendicitis: prospective evaluation with high-resolution CT. Radiology 1991;180:21–24.
- Safran DB, Pilati D, Folz E, Oller D. Is appendiceal CT scan overused for evaluating patients with right lower quadrant pain? Am J Emerg Med 2001;19:199–203. doi:10.1053/ajem.2001.21721. CrossRef
- Hong JJ, Cohn SM, Ekeh AP, et al. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt) 2003;4:231–239. doi:10.1089/109629603322419562. CrossRef
- Antevil JL, Rivera L, Langenberg BJ, et al. Computed tomography-based clinical diagnostic pathway for acute appendicitis: prospective validation. J Am Coll Surg 2006;203:849–856. doi:10.1016/j.jamcollsurg.2006.08.012. CrossRef
- Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician 1999;60:2027–2034.
- Yamini D, Vargas H, Bongard F, et al. Perforated appendicitis: is it truly a surgical urgency? Am Surg 1998;64:970–975.
- Foley TA, Earnest FT, Nathan MA, et al. Differentiation of nonperforated from perforated appendicitis: accuracy of CT diagnosis and relationship of CT findings to length of hospital stay. Radiology 2005;235:89–96. doi:10.1148/radiol.2351040310. CrossRef
- Oliak D, Sinow R, French S, et al. Computed tomography scanning for the diagnosis of perforated appendicitis. Am Surg 1999;65:959–964.
- Mutter D, Vix M, Bui A, et al. Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Surgery 1996;120:71–74. doi:10.1016/S0039-6060(96)80243-1. CrossRef
- United States Census (2000). http://www.census.gov/main/www/cen2000.html. Accessed January 3, 2009.
- Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg 2006;202:401–406. doi:10.1016/j.jamcollsurg.2005.11.016. CrossRef
- Christopher FL, Lane MJ, Ward JA, Morgan JA. Unenhanced helical CT scanning of the abdomen and pelvis changes disposition of patients presenting to the emergency department with possible acute appendicitis. J Emerg Med 2002;23:1–7. doi:10.1016/S0736-4679(02)00453-5. CrossRef
- Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer acceptable. Am J Surg 1997;174:723–726. discussion 726-727. doi:10.1016/S0002-9610(97)00183-9. CrossRef
- Bratton SL, Haberkern CM, Waldhausen JH. Acute appendicitis risks of complications: age and Medicaid insurance. Pediatrics 2000;106:75–78. doi:10.1542/peds.106.1.75. CrossRef
- Braveman P, Schaaf VM, Egerter S, et al. Insurance-related differences in the risk of ruptured appendix. N Engl J Med 1994;331:444–449. doi:10.1056/NEJM199408183310706. CrossRef
- CT Scans and Acute Appendicitis: A Five-Year Analysis from a Rural Teaching Hospital
Journal of Gastrointestinal Surgery
Volume 13, Issue 7 , pp 1306-1312
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Perforated appendicitis
- CT scan
- Delay in treatment
- Gender difference
- Rural population
- Industry Sectors